Take Your Best Stab, Then Hope for the Best

"Meredith? Jan. I need to reschedule my interview with Dr. P. I overslept, my blood sugar is 50, and I can’t get out of my driveway."

And thus began my day.

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I’d waited a week to get that interview. It would be another five days before the doctor would be available again. In the meantime, a deadline was looming.

Blasted diabetes. Oversleeping by itself would have merely meant throwing on some clothes and dashing out of the house. Can’t get out of the driveway because of never-ending construction in my neighborhood? So I’d just tear up the back yard. Some more.

But the low blood glucose, or hypoglycemia, couldn’t be ignored. No matter how well I felt, the number on my continuous glucose monitor (CGM), and confirmed by my meter, told me it would be unwise to get behind a wheel and hit the road.

I also wondered what in the blue blazes I did wrong this time. It had been a fairly “vanilla” day, and I hadn’t eaten anything out of the ordinary. Did I miscalculate my insulin dose? Were fluctuating hormones playing havoc with my insulin sensitivity? Had I been more active than I thought? Was restless sleep (hence more activity) at the bottom of it?

Who knows? And, as I found out years ago, not even the experts always know why blood glucose doesn’t do what’s expected.

It was in the days of two injections a day of NPH and Regular. Terrible regimen—makes me shudder just to think of all the clock-watching I had to do to maintain some semblance of good blood glucose control.

On the day I’m talking about, I checked my blood glucose—130 mg/dl—gave myself an injection of Regular, which needed to be taken half an hour before eating, and made dinner. Precisely half an hour later, as I was plating dinner for my husband and myself, the room started to spin. I checked again and my meter read 33 mg/dl.

I couldn’t wait to see my endocrinologist: He’d have the answer for me, because I sure didn’t know why I was just fine when I began preparing dinner and was fighting to remain conscious half an hour later.

His response when I asked? “I don’t know. Sometimes those things just happen.”

“I don’t know.” Great. Just what I wanted to hear. But, as I found out when I learned more about diabetes myself, it’s sometimes the only answer you’re going to get. As they say, the only thing consistent about diabetes is its inconsistency. You can do the same things and eat the same foods in the same amounts day after day, but your blood glucose isn’t going to behave itself. There are just too many other variables, from something obvious like the sniffles or the flu, to the less obvious, such as fluctuating hormones or a comet coming too close to the earth.

There was an Associated Press article this week about continuous glucose monitors that mentioned the “ultimate goal” of pairing a CGM “with implanted [insulin] pumps that would automatically dispense insulin to make a diabetic’s blood sugar better resemble a healthy person’s.”

I’ll ignore “diabetic” and “healthy person” for now, and get on with the artificial pancreas bit.

While an artificial pancreas sounds good—a glucose monitor “tells” the pump when you need a hit of insulin—I’ve been in too many situations where things didn’t make sense when it came to my blood glucose. I’m not about to trust a machine to regulate it.

For example, will it have a reservoir of sugar for when you’re tumbling toward hypoglycemia? Will it have a hormone sensor so it can adjust for extra estrogen or whatever? How about a chart telling it how far you’ve bicycled, walked, run, or swum? How small can engineers shrink that astrological chart that will tell it what position the planets are in?

Nope. I’ll look at my CGM, check highs or lows with my meter, and adjust my own insulin doses based on the numbers plus whatever variables I know about, thank you very much.

Jan Chait: Jan Chait was diagnosed with Type 2 diabetes in January 1986. Since then, she has run the gamut of treatments, beginning with diet and exercise. She now uses an insulin pump to help treat her diabetes.

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